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i 01/27/2004 16:55 FAX 14024714429 NEBRASKA UCC 1008 Department of the Treasury - Internal Revenue Service Form 668 (Y)(c) (Rev. October 2000) Notice of Federal Tax Lien IA 004/004 Area: Serial Number For OntinnAl I I.o tip• o„ ^- -- ^ iTL - SMALL BUSINESS /SELF EMPLOYED AREA 49 w� s.� o: s4.�. - ucc Lien Unit Phone: (651) 312 -8080 152676704 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following -named taxpayer. We have made . a demand for payment of this Ilability, but it remains unpaid. Therefore, 9904314812 -5 Po:: f P there is a lien in favor of the United States on all property and rights to 1WZ7► 004 10 49 PM Filled: 0 property belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer THOMAS A WAGONER , a Corporation 200400816 Residence 1819 W NORTH FRONT ST GRAND ISrLAND, NE 68803 -4706 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unless notice of the lien is refiled by the date given in column (e), this notice shall, on the day following such date, operate as a certificate of release as defined in IRC 6325(a). Tax Period Date of last Dayy for Unpaid Balance Kind of Tax Ending Identifying Number. Assessment Refiling of Assessment (a) (b) (c) (d) (e) (f) 941 06/30/2002 47- 0550792 09/23/2002 10/23/2012 47.24 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 47.24 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 21st day of January 2004 ST PAUL, MN on this, Signature Title REVENUE OFFICER 29 -10 -1726 for KATHY MALLETT (402) 361 -0250 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Ro„ Rul. 71 -466. 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 10 -00)